USE NURSE CO-VISITS TO IMPROVE ACCESS TO CARE

Our ambulatory clinics have started using nurse co-visits to expand same-day access without increasing physician workload, following a model published in 2015.¹

These visits are mostly for minor acute issues, such as upper respiratory infections, urinary tract infections, or earaches. The nurse takes the history of present illness and past medical and family histories, collects vitals, implements standing orders, and creates a note. When the physician joins the visit, the nurse recaps the history with the patient in the room, available to fill in any gaps. The physician then conducts the exam and documents a brief assessment and plan. The physician also verifies the visit documentation so a bill can be submitted. The nurse then reviews the care plan with the patient and provides any necessary education.

After an initial pilot between October 2022 and February 2023, our clinicians reported higher levels of job satisfaction and enthusiasm and more of our nurses reported working at the top of their license and being confident rooming patients.

We are now expanding the nurse co-visit model to newborn care, with registered nurses performing the rooming tasks using the pediatric wellness questionnaire (basic questions about breastfeeding, bowel movements, etc.) and then documenting all but the plan using a templated note our system developed. Early data shows that this has improved our rate of seeing low-risk newborns within three days of hospital discharge, from 75.9% to 86.7%.